Future role of MD/DO in relation to APNs/PAs.

[sramsay]

I wasn't sure where this belonged, but given the amount of politics involved in the discussion, this seemed like an appropriate spot for it.

With the roles and independence of APNs and PAs expanding, one question I'm left pondering is "What does the future hold in terms of multi-disciplinary collaboration?" Historically, the physician has served as a sort of director of care, but with practice rights of midlevels growing closer and closer to equivalent, it seems unlikely that things will remain that way in the long term.

Frankly, I think we're heading to a point where the line between the job descriptions of midlevels and physicians becomes blurry. Yes, nurses are supposed to be more holistically oriented, but IMO in practice it's a pretty weak distinction. I guess my question is what is the place of the physician in the future of healthcare? As a student nurse myself, I'm all for the expansion of the scope of APN practice to the extent that training renders the practice safe and competent. Simultaneously, I acknowledge that the physician's education is significantly more comprehensive than an APNs, and while the APN's education is sufficient to afford the provision of competent care, that there will always be a place for the physician.

The question is what will that place be? How will the collaboration between APNs and physicans work in the future? Will the APN occupy the role of primary care provider and physicians continue towards specialization? Will the roles eventually become roughly equivalent as in the difference between MD and DO? Will physicians move largely in to research?

I feel I can speak for others in my position -- a young student -- when I say that all of this is very relevant to me. I'm at a crossroads in my life where I know that I want to become a provider of care, but am torn between staying the path of nursing or pursuing a medical education.

[wowza]

I wasn't sure where this belonged, but given the amount of politics involved in the discussion, this seemed like an appropriate spot for it.With the roles and independence of APNs and PAs expanding, one question I'm left pondering is "What does the future hold in terms of multi-disciplinary collaboration?" Historically, the physician has served as a sort of director of care, but with practice rights of midlevels growing closer and closer to equivalent, it seems unlikely that things will remain that way in the long term.Frankly, I think we're heading to a point where the line between the job descriptions of midlevels and physicians becomes blurry. Yes, nurses are supposed to be more holistically oriented, but IMO in practice it's a pretty weak distinction. I guess my question is what is the place of the physician in the future of healthcare? As a student nurse myself, I'm all for the expansion of the scope of APN practice to the extent that training renders the practice safe and competent. Simultaneously, I acknowledge that the physician's education is significantly more comprehensive than an APNs, and while the APN's education is sufficient to afford the provision of competent care, that there will always be a place for the physician.The question is what will that place be? How will the collaboration between APNs and physicans work in the future? Will the APN occupy the role of primary care provider and physicians continue towards specialization? Will the roles eventually become roughly equivalent as in the difference between MD and DO? Will physicians move largely in to research?I feel I can speak for others in my position -- a young student -- when I say that all of this is very relevant to me. I'm at a crossroads in my life where I know that I want to become a provider of care, but am torn between staying the path of nursing or pursuing a medical education.

The distinction here is the difference in education. MD and DO education is equivalent and very standardized. It involves 2 years of classwork and roughly 4000 clinical hours during school and roughly 12-20K more clincal hours during residency. The the depth and breadth of the DNP does not even come close to what is in the MD and DO curricula whether you compare raw class hours, raw clinical hours, or the lack of "fluff" courses like research and nursing activism.

Furthermore, the DNP suffers from multiple things:

1) It doesn't have a true identity. It is a mix between a MPH and a clinical degree yet is supposed to be a step up from the clinical degree

2) The students often have to set up their own clinicals and the clinicals are very variable in terms of quality

3) the coursework is a patchwork of fluff courses and true clinical course.

Nursing activism, research, epidemiology do not have a place in a clinical doctorate unless they don't detract from the clincal courses. As it stands now, they take the place of extra clinical hours and more path/pharm/phys

So despite the lobbying, the degrees arent equivalent despite what the nursing lobby would have you believe. Really, if you compare the MSN and the DNP curricula, the only changes are the extra fluff courses rather than more clinical courses. There seems to be a movement where the nursing students are asking for a more rigorous education and I applaud this. However until this happens, the 3 degrees won't be equivalent.

[zoidberg, BSN, RN]

this is not about the dnp. that is a degree. NP's have a license. the NP depends on this. I believe and sincerely hope physicians stay in primary care. my primary care MD is one of the smartest, most caring people i know, and having MD's in primary care can catch things that an NP or PA would not.

second, i do not think the OP suggested NP education to be anywhere on the same level as medical education, but rather the roles of health care. I do not support it, but with the time and money of med school, i bet a shift to APN and PA's as primary providers is happening as we speak. I do not think they wil replace physicians, but maybe just spread them out. MD's with multiple extenders is a likely model for primary care.

[czyja, MSN, RN]

I think we are headed towards more collaboration and delivery of care in integrated practice settings like kaiser, group health, geissinger, etc.Thus APRNs will continue have an increasing role.The evidence suggests that APRNs deliver the same quality of care as physicians in the primary care arena. Also fewer MDs are interested I primary care d/t the relatively low pay when compared to specialty practice. So I think we will see more aprns in primary care.FYI- by in large most APRNs (including yours truly) hate the term mid-level provider. It suggests a lower level of care than that provided by a physician, which is simply not the case.

[cayenne06, MSN, CNM]

Wowza, the OP clearly stated that the two educations are not equivalent. However, I still agree with everything you said and I hope the DNP degree becomes more rigorous and standardized, for the benefit of patients AND the nursing profession.

Anyway, I wonder this as well. As a CPM on her way to CNM, this is something I think about a lot. I think OBGYN is a great example of positive, mutually beneficial collaboration between midlevels and MDs.

[sirI, MSN, APRN, NP]

Wowza, the OP clearly stated that the two educations are not equivalent. However, I still agree with everything you said and I hope the DNP degree becomes more rigorous and standardized, for the benefit of patients AND the nursing profession.

Anyway, I wonder this as well. As a CPM on her way to CNM, this is something I think about a lot. I think OBGYN is a great example of positive, mutually beneficial collaboration between midlevels and MDs.

As of right now:

. Although several schools of nursing in which nurse-midwifery education programs reside are beginning to offer the DNP degree, the American Midwifery Certification Board (AMCB) will not be requiring the DNP as an entry to practice requirement for midwifery certification.

FAQs for Prospective Students

[elkpark]

Interesting question (the original question, not the beating-a-dead-horse tangent about DNP curricula) -- in my experience over the years, many physicians are more than happy to have APNs assume the care management/coordination/oversight aspects in order to keep them (physicians) free to "just" practice medicine without having to worry about all the other stuff. That seems like a good model to me.